ArticleInternational journal of epidemiology2021
Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999-2015.
Article in International journal of epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Interplay of glycated hemoglobin and traditional risk factors for the risk of atherosclerotic cardiovascular disease and all-cause mortality in people without diabetes.Cardiovascular diabetology · 2025Observational
- An interpretable machine learning model with demographic variables and dietary patterns for ASCVD identification: from U.S. NHANES 1999-2018.BMC medical informatics and decision making · 2025Article
- Diabetes Mellitus, Preoperative Glycemic Control and Postoperative Outcomes: A Multi-Ethnic Asian Perspective.Clinical medicine insights. Endocrinology and diabetes · 2025Article
- U-shaped association between HbA1c and all-cause mortality in CVD patients with diabetes.Scientific reports · 2024Article
- Causal inference and machine learning in endocrine epidemiology.Endocrine journal · 2024Review
- Prospective cohort studies underscore the association of abnormal glycemic measures with all-cause and cause-specific mortalities.iScience · 2024Article
- Association between the stress-hyperglycemia ratio and all-cause mortality in community-dwelling populations: An analysis of the National Health and Nutrition Examination Survey (NHANES) 1999-2014.Journal of diabetes · 2024Article
- Terminal trajectory of HbAFrontiers in endocrinology · 2024Article
- Machine learning for the prediction of atherosclerotic cardiovascular disease during 3-year follow up in Chinese type 2 diabetes mellitus patients.Journal of diabetes investigation · 2023Article
- Relationship of Glycated Hemoglobin A1c with All-Cause and Cardiovascular Mortality among Patients with Hypertension.Journal of clinical medicine · 2023Article
- The role of age on the risk relationship between prediabetes and major morbidities and mortality: Analysis of the Hong Kong diabetes surveillance database of 2 million Chinese adults.The Lancet regional health. Western Pacific · 2023Article
- Predictive Value of HbA1c and Metabolic Syndrome for Renal Outcome in Non-Diabetic CKD Stage 1-4 Patients.Biomedicines · 2022Article
- Associations between glycated hemoglobin and the risks of incident cardiovascular diseases in patients with gout.Cardiovascular diabetology · 2022Article
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- Associations of impaired glucose tolerance and sleep disorders with mortality among the US general population.BMJ open diabetes research & care · 2021Article
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9 authors.
Funding
Abstract
objectiveIt is unclear whether relatively low glycated haemoglobin (HbA1c) levels are beneficial or harmful for the long-term health outcomes among people without diabetes. We aimed to investigate the association between low HbA1c levels and mortality among the US general population.
methodsThis study includes a nationally representative sample of 39 453 US adults from the National Health and Nutrition Examination Surveys 1999-2014, linked to mortality data through 2015. We employed the parametric g-formula with pooled logistic regression models and the ensemble machine learning algorithms to estimate the time-varying risk of all-cause and cardiovascular mortality by HbA1c categories (low, 4.0 to <5.0%; mid-level, 5.0 to <5.7%; prediabetes, 5.7 to <6.5%; and diabetes, ≥6.5% or taking antidiabetic medication), adjusting for 72 potential confounders including demographic characteristics, lifestyle, biomarkers, comorbidities and medications.
resultsOver a median follow-up of 7.5 years, 5118 (13%) all-cause deaths, and 1116 (3%) cardiovascular deaths were observed. Logistic regression models and machine learning algorithms showed nearly identical predictive performance of death and risk estimates. Compared with mid-level HbA1c, low HbA1c was associated with a 30% (95% CI, 16 to 48) and a 12% (95% CI, 3 to 22) increased risk of all-cause mortality at 5 years and 10 years of follow-up, respectively. We found no evidence that low HbA1c levels were associated with cardiovascular mortality risk. The diabetes group, but not the prediabetes group, also showed an increased risk of all-cause mortality.
conclusionsUsing the US national database and adjusting for an extensive set of potential confounders with flexible modelling, we found that adults with low HbA1c were at increased risk of all-cause mortality. Further evaluation and careful monitoring of low HbA1c levels need to be considered.
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